Keywords
Diabetes, Self-Care Behavior, Health Literacy, Attitude, Behavior Change
Abstract
Background. Improved health literacy and awareness could help type 2 diabetic patients to control the disease complications. Objective. The current study aimed to evaluate the impact of theory-based educational intervention on health literacy and self-care behaviors of type 2 diabetic patients in Tonekabon city.
Methods. This randomized controlled trial study was conducted at health care centers in Tonekabon city, Iran, from April 5, 2017, to October 22, 2018. Using multistage random sampling, 166 patients with type 2 diabetes divided into two groups: theory- based intervention (n = 83) and custom education (n = 83). The data collection tools consisted of demographic information, Theory of Planned Behavior (TPB) measures, health literacy for Iranian adults (HELIA) and summary of diabetes self-care activities (SDSCA). The five 45-minute group training sessions based on the baseline assessment and model constructs along with the targeted pamphlet and m-health strategy were designed for the experimen- tal group. Data were analyzed using chi-square, independent and paired t-test and Analysis of covariance (ANCOVA).
Results. After controlling for pre-test effect, there was a signifi- cant difference between the two groups in terms of mean scores of attitudes, subjective norms, perceived behavior control and inten- tion in post-test (P < 0.001). Also, after controlling for the pre-test effect, the results showed a significant difference in the self-care domain in the post-test (P < 0.001). Finally, after controlling for the pre-test variable effect, covariance analysis reflects significant difference in total health literacy score and its dimension at posttest (P < 0.001).
Conclusions. Applying TPB based education is suggested to maintain and improve self-care behaviors and health literacy in type 2 diabetic patients and other chronic diseases.
References
1. Gonzalvo JD. Introduction to basal insulin therapy: clinical management of diabetes. Am J Manag Care. 2018 Mar; 24(6 Suppl):S87-S92. Review.
2. Rydén L, Ferrannini G, Mellbin L. Risk factor reduction in type 2 diabetes demands a multifactorial approach. Eur J Prev Cardiol. 2019 Dec; 26(2_suppl):81-91.
3. Shepard BD. Sex Differences in Diabetes and Kidney Disease: Mechanisms and Consequences. Am J Physiol Renal Physiol. 2019 Jun 26. doi: 10.1152/ajprenal.00249.2019.
4. Bommer C, Heesemann E, Sagalova V, Manne-Goehler J, Atun R, Bärnighausen T, Vollmer S. The global economic burden of diabetes in adults aged 20-79 years: a cost-of-illness study. Lancet Diabetes Endocrinol. 2017 Jun; 5(6):423-430.
5. Cho NH, Shaw JE, Karuranga S, Huang Y, da Rocha Fernandes JD, Ohlrogge AW, Malanda B. IDF Diabetes Atlas: Global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract. 2018 Apr;138: 271-281.
6. Standl E, Khunti K, Hansen TB, Schnell O. The global epidemics of diabetes in the 21st century: Current situation and perspectives. Eur J Prev Cardiol. 2019 Dec; 26(2_suppl):7-14.
7. Akbarzadeh A, Salehi A, Molavi Vardanjani H, Poustchi H, Gandomkar A, Fattahi MR, Malekzadeh R. Epidemiology of Adult Diabetes Mellitus and its Correlates in Pars Cohort Study in Southern Iran. Arch Iran Med. 2019 Nov 1; 22(11):633-639.
8. Stokes J, Gellatly J, Bower P, Meacock R, Cotterill S, Sutton M, Wilson P. Implementing a national diabetes prevention programme in England: lessons learned. BMC Health Serv Res. 2019 Dec 23; 19(1):991.
9. Yang E, Kim HJ, Ryu H, Chang SJ. Diabetes self-care behaviors in adults with disabilities: A systematic review. Jpn J Nurs Sci. 2019 Nov 5:e12289.
10. Mogre V, Johnson NA, Tzelepis F, Shaw JE, Paul C. A systematic review of adherence to diabetes self-care behaviours: Evidence from low- and middle-income countries. J Adv Nurs. 2019 Dec; 75(12):3374-3389.
11. Sharma S, Mishra AJ. Diabetes self-care management: Experiences of the socio-economically backward sections of Jammu. Diabetes Metab Syndr. 2019 Mar - Apr; 13(2):1281-1286.
12. Nelson LA, Ackerman MT, Greevy RA Jr, Wallston KA, Mayberry LS. Beyond Race Disparities: Accounting for Socioeconomic Status in Diabetes Self-Care. Am J Prev Med. 2019 Jul; 57(1):111-116.
13. Vosoghi Karkazloo N, Abootalebi Daryasari G, Farahani B, Mohammadnezhad E, Sajjadi A. The study of self-care agency in patients with diabetes. (Ardabil) Modern Care Journal. 2012; 8(4):197–204.[Google Scholar]
14. Parham M, Riahin A, Jandaghi M, Darivandpour A. Self-Care Behaviors of Diabetic Patients in Qom. Qom Univ Med Sci J. 2012; 6 (4): 81-87. (In Persian)
15. Huang CH, Lin PC, Chang Yeh M, Lee PH. A Study on Self-Care Behaviors and Related Factors in Diabetes Patients. u Li Za Zhi. 2017 Feb; 64(1):61-69.
16. Ishikawa H, Takeuchi T, Yano E. Measuring functional, communicative, and critical health literacy among diabetic patients. Diabetes Care. 2008; 31:874–879.
17. Bohanny W, Wu SF, Liu CY, Yeh SH, Tsay SL, Wang TJ. Health literacy, self-efficacy, and self-care behaviors in patients with type 2 diabetes mellitus. J Am Assoc Nurse Pract. 2013; 25(9):495-502.
18. Garcia-Codina O, Juvinyà-Canal D, Amil-Bujan P, Bertran-Noguer C, González-Mestre MA, Masachs-Fatjo E, et al. Determinants of health literacy in the general population: results of the Catalan health survey. BMC Public Health. 2019 Aug 16; 19(1):1122.
19. Platter H, Kaplow K, Baur C. Community Health Literacy Assessment: A Systematic Framework to Assess Activities, Gaps, Assets, and Opportunities for Health Literacy Improvement. Health Lit Res Pract. 2019 Oct 10; 3(4):e216-e226.
20. Rudd RE. Health Literacy: Insights and Issues. Stud Health Technol Inform. 2017; 240:60-78.
21. Shieh C, Halstead JA. Understanding the impact of health literacy on women's health. Journal of Obstetric, Gynecologic, & Neonatal Nursing. 2009; 38(5):601-612.
22. Tehrani Bani hashemi S, Amirkhani MA, Haghdoost AA, Alavian S, Asgharifard H, Baradaran H, et al. Health Literacy and the Influencing Factors: A Study in Five Provinces of Iran. Strides Dev Med Educ.2007; 4(1):1–9.
23. Beck J, Greenwood DA, Blanton L, Bollinger ST, Butcher MK, Condon JE, et al.
2017 National Standards for Diabetes Self-Management Education and Support. Diabetes Educ. 2019 Feb; 45(1):34-49.
24. Nijland N, van Gemert-Pijnen JE, Kelders SM, Brandenburg BJ, Seydel ER. Factors influencing the use of a Web-based application for supporting the self-care of patients with type 2 diabetes: a longitudinal study. J Med Internet Res. 2011; 13:e71.
25. Al-Durra M, Torio MB, Cafazzo JA. The use of behavior change theory in Internet-based asthma self-management interventions: a systematic review. J Med Internet Res. 2015 Apr 2; 17(4):e89.
26. Li ASW, Figg G, Schüz B. Socioeconomic Status and the Prediction of Health Promoting Dietary Behaviours: A SystematicReview and Meta-Analysis Based on the Theory of Planned Behaviour. Appl Psychol Health Well Being. 2019 Nov; 11(3):382-406.
27. Starfelt Sutton LC, White KM. Predicting sun-protective intentions and behaviours using the theory of planned behaviour: a systematic review and meta-analysis. Psychol Health. 2016 Nov; 31(11):1272-92.
28. McDermott MS, Oliver M, Simnadis T, Beck EJ, Coltman T, Iverson D, Caputi P, Sharma R. The Theory of Planned Behaviour and dietary patterns: A systematic review and meta-analysis. Prev Med. 2015 Dec; 81:150-6. doi: 10.1016/j.ypmed.2015.08.020. Epub 2015 Sep 5. Review.
29. Cooke R, Dahdah M, Norman P, French DP. How well does the theory of planned behaviour predict alcohol consumption? A systematic review and meta-analysis. Health Psychol Rev. 2016 Jun; 10(2):148-67.
30. Fishbein M, Ajzen I. Predicting and changing behavior: The reasoned action approach. New York: Psychology Press, 2010.
31. Thomason TR, Mayo AM. A Critique of the Short Test of Functional Health Literacy in Adults. Clin Nurse Spec. 2015 Nov-Dec; 29(6):308-12.
32. Reisi M, Mostafavi F, Javadzade H, Mahaki B, Tavassoli E, Sharifirad G. Communicative and critical health literacy and self-care behaviors in patients with type 2 diabetes. Iran J Diabetes Metab. 2015; 14(3):199-208. (In Persian)
33. Jalaludin M, Fuziah M, Hong J, Mohamad Adam B, Jamaiyah H. Reliability and Validity of the Revised Summary of Diabetes Self-Care Activities (SDSCA) for Malaysian Children and Adolescents. Malays Fam Physician. 2012 Aug 31; 7(2-3):10-20.
34. Kim SH, Lee A. Health-Literacy-Sensitive Diabetes Self-Management Interventions: A Systematic Review and Meta-Analysis. Worldviews Evid Based Nurs. 2016 Aug; 13(4):324-33.
35. Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Viera A, Crotty K, Holland A, Brasure M, Lohr KN, Harden E, Tant E, Wallace I, Viswanathan M. Health literacy interventions and outcomes: an updated systematic review. Evid Rep Technol Assess (Full Rep). 2011 Mar; (199):1-941.
36. Zhao RY, He XW, Shan YM, Zhu LL, Zhou Q. A stewardship intervention program for safe medication management and use of antidiabetic drugs. Clin Interv Aging. 2015 Jul 23; 10:1201-12.
37. Paiva D, Silva S, Severo M, Moura-Ferreira P, Lunet N, Azevedo A. Reply to the Letter to the Editor: "Limited Health Literacy in Portugal Assessed with the Newest Vital Sign". Acta Med Port 2018 Mar 29; 31(3):183-184.
38. Rezaee Esfahrood Z, Haerian ardekani A, Rahmanian M, Ghaffari Targhi M. A Survey on Health Literacy of Referred Diabetic Patients to Yazd Diabetes Research Center. TB. 2016; 15 (3):176-186. (In Persian)
39. Fransen MP, von Wagner C, Essink-Bot ML. Diabetes self-management in patients with low health literacy: ordering findings from literature in a health literacy framework. Patient Educ Couns. 2012 Jul; 88(1):44-53.
40. Hejazi S, Peyman N, Tajfard M, Esmaily H. The Impact of Education Based on Self-efficacy Theory on Health Literacy, Self-efficacy and Self-care Behaviors in Patients with Type 2 Diabetes. Iran J Health Educ Health Promot 2018; 5 (4): 296-303. (In Persian)
41. Long AF, Gambling T. Enhancing health literacy and behavioural change within a tele-care education and supportintervention for people with type 2 diabetes. Health Expect. 2012 Sep; 15(3):267-82.
42. Noordman J, van Vliet L, Kaunang M, van den Muijsenbergh M, Boland G, van Dulmen S. Towards appropriate information provision for and decision-making with patients with limited health literacy in hospital-based palliative care in Western countries: a scoping review into available communication strategies and tools for healthcare providers. BMC Palliat Care. 2019 Apr 12; 18(1):37.
43. Lee TW, Lee SH, Kim HH, Kang SJ. Effective intervention strategies to improve health outcomes for cardiovascular disease patients with low health literacy skills: a systematic review. Asian Nurs Res (Korean Soc Nurs Sci). 2012 Dec; 6(4):128-36.
44. Beiranvand S, Asadizaker M, Fayazi S, Yaralizadeh M. Efficacy of an Intervention Based on the Theory of Planned Behavior on Foot Care Performance in Type II Diabetic Patients, Jundishapur J Chronic Dis Care. 2016; 5(1):e30622. doi: 10.17795/jjcdc-30622.
45. Taha NM, Zaton HK, Abd Elaziz NH. Impact of a health educational guideline on the knowledge, self-management practice and self-efficacy of patients with type-2 diabetes. Journal of Nursing Education and Practice 2016; 6 (9): 46-55.
46. Reisi M, Javadzede H, Sharifirad G, Mostafavi F, Tavassoli E, Imanzad M. Effects of an Educational Intervention on Self-Care and Metabolic Control in Patients With Type II Diabetes. JCCNC. 2017; 3 (3): 205-214.
47. Zhao FF, Suhonen R, Koskinen S, Leino-Kilpi H. Theory-based self-management educational interventions on patients with type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials. J Adv Nurs. 2017 Apr; 73(4):812-833.
48. Saad AMJ, Younes ZMH, Ahmed H, Brown JA, Al Owesie RM, Hassoun AAK. Self-efficacy, self-care and glycemic control in Saudi Arabian patients with type 2 diabetes mellitus: A cross-sectional survey. Diabetes Res Clin Pract. 2018 Mar; 137:28-36.
49. Karimy M, Koohestani HR, Araban M. The association between attitude, self-efficacy, and social support and adherence to diabetes self-care behavior. Diabetol Metab Syndr. 2018 Nov 27; 10:86.
50. Dousti F, Maleki A, Chiti H, Faghihzadeh S, Taheri S S. Investigation of the Effect of Individual Counseling of Physical Activity Based on Theory of Planned Behavior on Glycemic Indexes in Women with Gestational Diabetes: A Randomized Clinical Trial. Qom Univ Med Sci J. 2018; 12 (9):26-37.
51. Rosal MC, Ockene IS, Restrepo A, White MJ, Borg A, Olendzki B, Scavron J, Candib L, Welch G, Reed G. Randomized trial of a literacy-sensitive, culturally tailored diabetes self-management intervention for low-income latinos: latinos en control. Diabetes Care. 2011 Apr; 34(4):838-44.
52. Song Y, Nam S, Park S, Shin IS, Ku BJ. The Impact of Social Support on Self-care of Patients With Diabetes: What Is the Effect of Diabetes Type? Systematic Review and Meta-analysis. Diabetes Educ. 2017 Aug; 43(4):396-412.
53. Faraji J, Soltanpour N, Lotfi H, Moeeini R, Moharreri AR, Roudaki S, Hosseini SA, Olson DM, Abdollahi AA, Soltanpour N, Mohajerani MH, Metz GAS. Lack of Social Support Raises Stress Vulnerability in Rats with a History of Ancestral Stress. Sci Rep. 2017 Jul 13; 7(1):5277.
54. Saleh LD, van den Berg JJ, Chambers CS, Operario D. Social support, psychological vulnerability, and HIV risk among African American men who have sex with men. Psychol Health. 2016 May; 31(5):549-64.
55. Graven LJ, Grant JS. Social support and self-care behaviors in individuals with heart failure: an integrative review. Int J Nurs Stud. 2014 Feb; 51(2):320-33.
56. Huang YM, Shiyanbola OO, Smith PD. Association of health literacy and medication self-efficacy with medication adherence and diabetes control. Patient Prefer Adherence. 2018 May 10; 12:793-802.
57. Al-Hashmi I, Hodge F, Nandy K, Thomas E, Brecht ML. The Effect of a Self-Efficacy-Enhancing Intervention on Perceived Self-Efficacy and Actual Adherence to Healthy Behaviors Among Women with Gestational Diabetes Mellitus. Sultan Qaboos Univ Med J. 2018 Nov; 18(4):e513-e519.
58. Mohammadi S, Karim NA, Talib RA, Amani R. The impact of self-efficacy education based on the health belief model in Iranian patients with type 2 diabetes: a randomized controlled intervention study. Asia Pac J Clin Nutr. 2018; 27(3):546-555.
59. Olson EA, McAuley E. Impact of a brief intervention on self-regulation, self-efficacy and physical activity in older adults with type 2 diabetes. J Behav Med. 2015 Dec; 38(6):886-98.
2. Rydén L, Ferrannini G, Mellbin L. Risk factor reduction in type 2 diabetes demands a multifactorial approach. Eur J Prev Cardiol. 2019 Dec; 26(2_suppl):81-91.
3. Shepard BD. Sex Differences in Diabetes and Kidney Disease: Mechanisms and Consequences. Am J Physiol Renal Physiol. 2019 Jun 26. doi: 10.1152/ajprenal.00249.2019.
4. Bommer C, Heesemann E, Sagalova V, Manne-Goehler J, Atun R, Bärnighausen T, Vollmer S. The global economic burden of diabetes in adults aged 20-79 years: a cost-of-illness study. Lancet Diabetes Endocrinol. 2017 Jun; 5(6):423-430.
5. Cho NH, Shaw JE, Karuranga S, Huang Y, da Rocha Fernandes JD, Ohlrogge AW, Malanda B. IDF Diabetes Atlas: Global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract. 2018 Apr;138: 271-281.
6. Standl E, Khunti K, Hansen TB, Schnell O. The global epidemics of diabetes in the 21st century: Current situation and perspectives. Eur J Prev Cardiol. 2019 Dec; 26(2_suppl):7-14.
7. Akbarzadeh A, Salehi A, Molavi Vardanjani H, Poustchi H, Gandomkar A, Fattahi MR, Malekzadeh R. Epidemiology of Adult Diabetes Mellitus and its Correlates in Pars Cohort Study in Southern Iran. Arch Iran Med. 2019 Nov 1; 22(11):633-639.
8. Stokes J, Gellatly J, Bower P, Meacock R, Cotterill S, Sutton M, Wilson P. Implementing a national diabetes prevention programme in England: lessons learned. BMC Health Serv Res. 2019 Dec 23; 19(1):991.
9. Yang E, Kim HJ, Ryu H, Chang SJ. Diabetes self-care behaviors in adults with disabilities: A systematic review. Jpn J Nurs Sci. 2019 Nov 5:e12289.
10. Mogre V, Johnson NA, Tzelepis F, Shaw JE, Paul C. A systematic review of adherence to diabetes self-care behaviours: Evidence from low- and middle-income countries. J Adv Nurs. 2019 Dec; 75(12):3374-3389.
11. Sharma S, Mishra AJ. Diabetes self-care management: Experiences of the socio-economically backward sections of Jammu. Diabetes Metab Syndr. 2019 Mar - Apr; 13(2):1281-1286.
12. Nelson LA, Ackerman MT, Greevy RA Jr, Wallston KA, Mayberry LS. Beyond Race Disparities: Accounting for Socioeconomic Status in Diabetes Self-Care. Am J Prev Med. 2019 Jul; 57(1):111-116.
13. Vosoghi Karkazloo N, Abootalebi Daryasari G, Farahani B, Mohammadnezhad E, Sajjadi A. The study of self-care agency in patients with diabetes. (Ardabil) Modern Care Journal. 2012; 8(4):197–204.[Google Scholar]
14. Parham M, Riahin A, Jandaghi M, Darivandpour A. Self-Care Behaviors of Diabetic Patients in Qom. Qom Univ Med Sci J. 2012; 6 (4): 81-87. (In Persian)
15. Huang CH, Lin PC, Chang Yeh M, Lee PH. A Study on Self-Care Behaviors and Related Factors in Diabetes Patients. u Li Za Zhi. 2017 Feb; 64(1):61-69.
16. Ishikawa H, Takeuchi T, Yano E. Measuring functional, communicative, and critical health literacy among diabetic patients. Diabetes Care. 2008; 31:874–879.
17. Bohanny W, Wu SF, Liu CY, Yeh SH, Tsay SL, Wang TJ. Health literacy, self-efficacy, and self-care behaviors in patients with type 2 diabetes mellitus. J Am Assoc Nurse Pract. 2013; 25(9):495-502.
18. Garcia-Codina O, Juvinyà-Canal D, Amil-Bujan P, Bertran-Noguer C, González-Mestre MA, Masachs-Fatjo E, et al. Determinants of health literacy in the general population: results of the Catalan health survey. BMC Public Health. 2019 Aug 16; 19(1):1122.
19. Platter H, Kaplow K, Baur C. Community Health Literacy Assessment: A Systematic Framework to Assess Activities, Gaps, Assets, and Opportunities for Health Literacy Improvement. Health Lit Res Pract. 2019 Oct 10; 3(4):e216-e226.
20. Rudd RE. Health Literacy: Insights and Issues. Stud Health Technol Inform. 2017; 240:60-78.
21. Shieh C, Halstead JA. Understanding the impact of health literacy on women's health. Journal of Obstetric, Gynecologic, & Neonatal Nursing. 2009; 38(5):601-612.
22. Tehrani Bani hashemi S, Amirkhani MA, Haghdoost AA, Alavian S, Asgharifard H, Baradaran H, et al. Health Literacy and the Influencing Factors: A Study in Five Provinces of Iran. Strides Dev Med Educ.2007; 4(1):1–9.
23. Beck J, Greenwood DA, Blanton L, Bollinger ST, Butcher MK, Condon JE, et al.
2017 National Standards for Diabetes Self-Management Education and Support. Diabetes Educ. 2019 Feb; 45(1):34-49.
24. Nijland N, van Gemert-Pijnen JE, Kelders SM, Brandenburg BJ, Seydel ER. Factors influencing the use of a Web-based application for supporting the self-care of patients with type 2 diabetes: a longitudinal study. J Med Internet Res. 2011; 13:e71.
25. Al-Durra M, Torio MB, Cafazzo JA. The use of behavior change theory in Internet-based asthma self-management interventions: a systematic review. J Med Internet Res. 2015 Apr 2; 17(4):e89.
26. Li ASW, Figg G, Schüz B. Socioeconomic Status and the Prediction of Health Promoting Dietary Behaviours: A SystematicReview and Meta-Analysis Based on the Theory of Planned Behaviour. Appl Psychol Health Well Being. 2019 Nov; 11(3):382-406.
27. Starfelt Sutton LC, White KM. Predicting sun-protective intentions and behaviours using the theory of planned behaviour: a systematic review and meta-analysis. Psychol Health. 2016 Nov; 31(11):1272-92.
28. McDermott MS, Oliver M, Simnadis T, Beck EJ, Coltman T, Iverson D, Caputi P, Sharma R. The Theory of Planned Behaviour and dietary patterns: A systematic review and meta-analysis. Prev Med. 2015 Dec; 81:150-6. doi: 10.1016/j.ypmed.2015.08.020. Epub 2015 Sep 5. Review.
29. Cooke R, Dahdah M, Norman P, French DP. How well does the theory of planned behaviour predict alcohol consumption? A systematic review and meta-analysis. Health Psychol Rev. 2016 Jun; 10(2):148-67.
30. Fishbein M, Ajzen I. Predicting and changing behavior: The reasoned action approach. New York: Psychology Press, 2010.
31. Thomason TR, Mayo AM. A Critique of the Short Test of Functional Health Literacy in Adults. Clin Nurse Spec. 2015 Nov-Dec; 29(6):308-12.
32. Reisi M, Mostafavi F, Javadzade H, Mahaki B, Tavassoli E, Sharifirad G. Communicative and critical health literacy and self-care behaviors in patients with type 2 diabetes. Iran J Diabetes Metab. 2015; 14(3):199-208. (In Persian)
33. Jalaludin M, Fuziah M, Hong J, Mohamad Adam B, Jamaiyah H. Reliability and Validity of the Revised Summary of Diabetes Self-Care Activities (SDSCA) for Malaysian Children and Adolescents. Malays Fam Physician. 2012 Aug 31; 7(2-3):10-20.
34. Kim SH, Lee A. Health-Literacy-Sensitive Diabetes Self-Management Interventions: A Systematic Review and Meta-Analysis. Worldviews Evid Based Nurs. 2016 Aug; 13(4):324-33.
35. Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Viera A, Crotty K, Holland A, Brasure M, Lohr KN, Harden E, Tant E, Wallace I, Viswanathan M. Health literacy interventions and outcomes: an updated systematic review. Evid Rep Technol Assess (Full Rep). 2011 Mar; (199):1-941.
36. Zhao RY, He XW, Shan YM, Zhu LL, Zhou Q. A stewardship intervention program for safe medication management and use of antidiabetic drugs. Clin Interv Aging. 2015 Jul 23; 10:1201-12.
37. Paiva D, Silva S, Severo M, Moura-Ferreira P, Lunet N, Azevedo A. Reply to the Letter to the Editor: "Limited Health Literacy in Portugal Assessed with the Newest Vital Sign". Acta Med Port 2018 Mar 29; 31(3):183-184.
38. Rezaee Esfahrood Z, Haerian ardekani A, Rahmanian M, Ghaffari Targhi M. A Survey on Health Literacy of Referred Diabetic Patients to Yazd Diabetes Research Center. TB. 2016; 15 (3):176-186. (In Persian)
39. Fransen MP, von Wagner C, Essink-Bot ML. Diabetes self-management in patients with low health literacy: ordering findings from literature in a health literacy framework. Patient Educ Couns. 2012 Jul; 88(1):44-53.
40. Hejazi S, Peyman N, Tajfard M, Esmaily H. The Impact of Education Based on Self-efficacy Theory on Health Literacy, Self-efficacy and Self-care Behaviors in Patients with Type 2 Diabetes. Iran J Health Educ Health Promot 2018; 5 (4): 296-303. (In Persian)
41. Long AF, Gambling T. Enhancing health literacy and behavioural change within a tele-care education and supportintervention for people with type 2 diabetes. Health Expect. 2012 Sep; 15(3):267-82.
42. Noordman J, van Vliet L, Kaunang M, van den Muijsenbergh M, Boland G, van Dulmen S. Towards appropriate information provision for and decision-making with patients with limited health literacy in hospital-based palliative care in Western countries: a scoping review into available communication strategies and tools for healthcare providers. BMC Palliat Care. 2019 Apr 12; 18(1):37.
43. Lee TW, Lee SH, Kim HH, Kang SJ. Effective intervention strategies to improve health outcomes for cardiovascular disease patients with low health literacy skills: a systematic review. Asian Nurs Res (Korean Soc Nurs Sci). 2012 Dec; 6(4):128-36.
44. Beiranvand S, Asadizaker M, Fayazi S, Yaralizadeh M. Efficacy of an Intervention Based on the Theory of Planned Behavior on Foot Care Performance in Type II Diabetic Patients, Jundishapur J Chronic Dis Care. 2016; 5(1):e30622. doi: 10.17795/jjcdc-30622.
45. Taha NM, Zaton HK, Abd Elaziz NH. Impact of a health educational guideline on the knowledge, self-management practice and self-efficacy of patients with type-2 diabetes. Journal of Nursing Education and Practice 2016; 6 (9): 46-55.
46. Reisi M, Javadzede H, Sharifirad G, Mostafavi F, Tavassoli E, Imanzad M. Effects of an Educational Intervention on Self-Care and Metabolic Control in Patients With Type II Diabetes. JCCNC. 2017; 3 (3): 205-214.
47. Zhao FF, Suhonen R, Koskinen S, Leino-Kilpi H. Theory-based self-management educational interventions on patients with type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials. J Adv Nurs. 2017 Apr; 73(4):812-833.
48. Saad AMJ, Younes ZMH, Ahmed H, Brown JA, Al Owesie RM, Hassoun AAK. Self-efficacy, self-care and glycemic control in Saudi Arabian patients with type 2 diabetes mellitus: A cross-sectional survey. Diabetes Res Clin Pract. 2018 Mar; 137:28-36.
49. Karimy M, Koohestani HR, Araban M. The association between attitude, self-efficacy, and social support and adherence to diabetes self-care behavior. Diabetol Metab Syndr. 2018 Nov 27; 10:86.
50. Dousti F, Maleki A, Chiti H, Faghihzadeh S, Taheri S S. Investigation of the Effect of Individual Counseling of Physical Activity Based on Theory of Planned Behavior on Glycemic Indexes in Women with Gestational Diabetes: A Randomized Clinical Trial. Qom Univ Med Sci J. 2018; 12 (9):26-37.
51. Rosal MC, Ockene IS, Restrepo A, White MJ, Borg A, Olendzki B, Scavron J, Candib L, Welch G, Reed G. Randomized trial of a literacy-sensitive, culturally tailored diabetes self-management intervention for low-income latinos: latinos en control. Diabetes Care. 2011 Apr; 34(4):838-44.
52. Song Y, Nam S, Park S, Shin IS, Ku BJ. The Impact of Social Support on Self-care of Patients With Diabetes: What Is the Effect of Diabetes Type? Systematic Review and Meta-analysis. Diabetes Educ. 2017 Aug; 43(4):396-412.
53. Faraji J, Soltanpour N, Lotfi H, Moeeini R, Moharreri AR, Roudaki S, Hosseini SA, Olson DM, Abdollahi AA, Soltanpour N, Mohajerani MH, Metz GAS. Lack of Social Support Raises Stress Vulnerability in Rats with a History of Ancestral Stress. Sci Rep. 2017 Jul 13; 7(1):5277.
54. Saleh LD, van den Berg JJ, Chambers CS, Operario D. Social support, psychological vulnerability, and HIV risk among African American men who have sex with men. Psychol Health. 2016 May; 31(5):549-64.
55. Graven LJ, Grant JS. Social support and self-care behaviors in individuals with heart failure: an integrative review. Int J Nurs Stud. 2014 Feb; 51(2):320-33.
56. Huang YM, Shiyanbola OO, Smith PD. Association of health literacy and medication self-efficacy with medication adherence and diabetes control. Patient Prefer Adherence. 2018 May 10; 12:793-802.
57. Al-Hashmi I, Hodge F, Nandy K, Thomas E, Brecht ML. The Effect of a Self-Efficacy-Enhancing Intervention on Perceived Self-Efficacy and Actual Adherence to Healthy Behaviors Among Women with Gestational Diabetes Mellitus. Sultan Qaboos Univ Med J. 2018 Nov; 18(4):e513-e519.
58. Mohammadi S, Karim NA, Talib RA, Amani R. The impact of self-efficacy education based on the health belief model in Iranian patients with type 2 diabetes: a randomized controlled intervention study. Asia Pac J Clin Nutr. 2018; 27(3):546-555.
59. Olson EA, McAuley E. Impact of a brief intervention on self-regulation, self-efficacy and physical activity in older adults with type 2 diabetes. J Behav Med. 2015 Dec; 38(6):886-98.